Healthcare Provider Details

I. General information

NPI: 1356190854
Provider Name (Legal Business Name): JASMINE C LOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 OTTER CIR
FAYETTEVILLE GA
30215-5264
US

IV. Provider business mailing address

227 OTTER CIR
FAYETTEVILLE GA
30215-5264
US

V. Phone/Fax

Practice location:
  • Phone: 678-308-1696
  • Fax:
Mailing address:
  • Phone: 678-308-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: